Objective: In recent years regional anesthesia has gained great popularity. However, like any other medical procedure, the regional anesthesia carries certain risk of unintended intraneural injection and consequential neurological complications. Studies in animals have suggested that intraneural application of local anesthetics may cause mechanical injury. Previous studies, however, have used small animal models and clinically irrelevant injection speed or equipment. In this study we used equipment and injection methods in common clinical use to study the consequences and pressure dynamics of intraneural injection. Our hypothesis is that an intraneural injection is heralded by higher injection pressure and leads to neurologic impairment in pigs.
Materials and Methods: Ten pigs of mixed breed (21-26 kg, 4-6 months old) were studied. After general anesthesia, the sciatic nerves (n = 20) were exposed bilaterally. Under direct vision, a 25-gauge insulated nerve block needle was placed either intraneurally (n = 10) or perineurally (n = 10), and 4 ml of preservative-free lidocaine 2% was injected using an automated infusion pump (15 ml/min). Injection pressure data were acquired using an in-line manometer coupled to a computer via an analog-to-digital conversion board. After injection, the animals were awakened and subjected to serial neurologic examinations during next 7 days.
Results: All perineural injections resulted in injection pressures below 40 kPa. In contrast, intraneural injections resulted in significantly higher peak pressures (P < 0.01). In seven (70%) intraneural injections, the injections pressures were over 140 kPa (140-350 kPa). Neurologic function returned to baseline within 24 hours in all sciatic nerve receiving perineural injections. In contrast, residual neurologic impairment was present in seven sciatic nerves after intraneural injection and was associated with injection pressures >140 k Pa.
Conclusion: High injection pressure (>140 kPa) predicts intraneural injection and consequential neurologic deficit. As long as the injection pressure is low, injection into poorly compliant tissue can be avoided and neurological complication can be prevented.

Saudi parent's attitude and practice about self-medicating their children

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Ahmed S EldaloDOI:10.4103/2045-080X.112985

Objective: The objective of this study was to test the parental self-medication attitude and practice toward their children in Saudi Arabia.
Materials and Methods: A cross-sectional study was conducted. Non-probability convenient random sampling method was used to select the participants. A total of 750 parents from different cities in the Saudi Arabia were involved in the study.
Results: The obtained response rate was 80%. The majority of participants were used to treat their children by western medicines. Most of respondents self-medicated their children in the month previous to the study period. The most common reported self-treated symptom was fever, although the most frequently used medicines were paracetamol and antibiotics. The attitude to treat fever was higher in males than in females (P = 0.021). The initial response for most participants in case of self treatment failure was to consult physicians in public hospitals; education level of participants showed significant difference (P = 0.041). The main reasons for self-medication were long waiting time in the clinics and high consultation fees. Occupation showed a significant differences (P = 0.008).
Conclusion: The current study revealed the fact that parental self-medication among public in Saudi Arabia is a routine practice. The researchers suggested introduction of parental educational interventions throughout the Saudi Arabia to ensure that children will receive best pharmaceutical care.

Objective: Improving productivity is one of the most important strategies for social-economic development. Human resources are known as the most important resources in the organizations' survival and success.
Aims: To determine the factors affecting the human resource productivity using the ACHIEVEa model from the nurses' perspective and then prioritize them from the perspective of head nurses using Analytic Hierarchy Process (AHP) technique.
Settings and Design: Iran, Shiraz University of Medical Sciences teaching hospitals in 2012.
Materials and Methods: This was an applied, cross-sectional and analytical-descriptive study conducted in two phases. In the first phase, to determine the factors affecting the human resource productivity from nurses' perspective, 110 nurses were selected using a two-stage cluster sampling method. Required data were collected using the Persian version of Hersey and Goldsmith's Human Resource Productivity Questionnaire. In the second phase, in order to prioritize the factors affecting human resource productivity based on the ACHIEVE model using AHP technique, pairwise comparisons matrices were given to the 19 randomly selected head nurses to express their opinions about those factors relative priorities or importance.
Statistical Analysis Used: Collected data and matrices in two mentioned phases were analyzed using SPSS 15.0 and some statistical tests including Independent-Samples T-Test and Pearson Correlation coefficient, as well as, Super Decisions software (Latest Beta).
Results: The human resource productivity had significant relationships with nurses' sex (P = 0.008), marital status (P < 0.001), education level (P < 0.001), and all questionnaire factors (P < 0.05). Nurses' productivity from their perspective was below average (44.97 ΁ 7.43). Also, the priorities of factors affecting the productivity of nurses based on the ACHIEVE model from the head nurses' perspective using AHP technique, from the highest priority to the lowest one, respectively, were: Clarity, Ability, Incentive, Evaluation, Help, Environment and Validity.Conclusions: According to the results and the priorities expressed by the head nurses in order to improve the productivity of nurses, providing the orientation, training and retraining courses for nurses, developing performance-based management systems and fair systems of reward and punishment, holding continuous performance evaluation and review meetings between individual nurses and their heads, increasing funding and improving organizational facilities, delegating authority to staff based on their abilities and capabilities, providing more welfare and recreational services and facilities such as nursery schools, transportation services, etc., for the nurses, esp. women nurses, are suggested.

Context: Antibiotic prescribing by physicians has gained due importance across the globe, mainly because of an increase in antibiotic usage, prevalence of infections, and drug resistances.
Aims: The present study aimed to evaluate the prescribing pattern of antibiotics, their adherence to essential medicines list, disease conditions for which they were prescribed, and their adverse effects.
Settings and Design: A cross-sectional prospective study was carried out in six inpatients departments (Surgery, Orthopedics, ENT, Ophthalmology, Medicine, and Pediatrics) of a 550-bed tertiary care hospital in Trivandrum, India for two months (July-August 2012). Institutional Research and Ethics Committee clearance were obtained prior to the study.
Materials and Methods: The data were collected in a predesigned performa from the medical case sheets, drug charts, and laboratory investigations of 100 in-patients. The enrolled patients were observed from admission till discharge. Descriptive statistics were applied to the collected data and analyzed using Microsoft Excel software.
Results: The mean duration of hospitalization among the study population was 5.48 (±4.28) days. Of the 410 medicines prescribed, antibiotics contributed 151 (36.8%). They were mostly indicated for respiratory infections, and the most common antibiotic was Beta-lactams (91 (60.2%). Interestingly, 89 antibiotics (60%) were administered as injections. About 70 (46%) of the antibiotics were prescribed without any combinations. The adherences to World Health Organization's essential medicines list were 122 (81%). A total of seven adverse drug reactions were reported in the current study. Of which, none were serious, and five (70%) were cutaneous reactions.
Conclusions: Of the 100 patients analyzed from six in-patient departments, it was observed that the hospital physicians prescribed antibiotics more rationally with no banned drugs and less newer drugs. Rational prescribing of antibiotics would help avoid polypharmacy and prevent drug resistances.

Introduction: Willis arterial circle (circulus arteriosus cerebri Willisi) is the most important part of the collateral circulatory system of the brain. It functions in normal and pathological situations such as valvular mechanism and thus allows optimal blood supply of all parts of the brain tissue, which reduces the risk of transient ischemic attack (TIA) and stroke. The main pre-requisite for the normal function of the circle is its completeness and the lack of hypoplastic vessels.
Materials and Methods: In this research, we used 100 angiograms of carotid system shown by serial angiography by Seldinger taken from the archives of the Department of Radiology, Clinical Center University of Sarajevo. For morphometric analysis of blood vessels, we used specially designed software program ELLIPSE (ViDiTo, Zoltan Tomoris, Kosice, Slovak Republic, tomori@saske.sk. In this way, it was possible to more easily store and analyze angiograms that were used for morphometric analysis.
Results: In our study, larger diameters of blood vessels in Willis circle were observed in the younger subjects compared to older except the diameter of the internal carotid artery, which was about 0.2 to 0.3 mm larger in the older subjects. In both age groups among males, we recorded larger diameters of the internal carotid artery and segment before the circle of the posterior cerebral artery in relation to the female population, while the rear communicating artery in females was 0.1 mm wider in diameter compared to men in category of younger respondents.